Symptoms of Ventral Hernia
Ventral hernias commonly present with a visible or palpable abdominal bulge that may disappear when lying down, often accompanied by localized pain or discomfort that worsens with activity. 1, 2
Uncomplicated Ventral Hernia Presentation
Typical symptoms include:
- Visible abdominal bulge or swelling that may reduce (disappear) when the patient lies in the prone position 1, 3
- Localized pain or aching sensation in the hernia area that typically worsens toward the end of the day and after prolonged physical activity 3
- Dragging or heavy sensation in the affected area, particularly with standing or straining 3
- Burning or gurgling sensation at the hernia site 3
- Many patients with small ventral hernias may be asymptomatic or minimally symptomatic 1
Complicated Ventral Hernia: Red Flag Symptoms
Critical warning signs requiring immediate surgical evaluation include:
- Irreducible swelling - the bulge cannot be pushed back into the abdomen, indicating incarceration 1
- Increasing or severe pain at the hernia site, suggesting possible strangulation 1
- Nausea and vomiting, which indicate bowel obstruction from incarcerated contents 1
- Skin changes over the hernia (redness, warmth, discoloration), suggesting compromised blood supply 1
- Systemic signs including fever or signs of systemic inflammatory response syndrome (SIRS), indicating potential bowel necrosis 1
Symptoms persisting for more than 8 hours are associated with significantly higher morbidity and require urgent evaluation. 1
Physical Examination Findings
- Palpable bulge or impulse detected while the patient coughs or performs Valsalva maneuver 3
- The hernia defect may be felt along the abdominal wall, with size varying from small (few centimeters) to massive defects (>10 cm) 4, 5
- Tenderness on palpation may indicate incarceration or early strangulation 1
- Guarding on physical examination is moderately predictive of bowel strangulation 6
Laboratory Abnormalities in Complicated Cases
When strangulation or bowel compromise is suspected, specific laboratory findings are predictive:
- Elevated arterial lactate (≥2.0 mmol/L) is the most useful predictor of non-viable bowel strangulation 6
- Elevated white blood cell count is independently predictive of bowel strangulation and significantly associated with morbidity 6
- Elevated fibrinogen levels are significantly predictive of incarcerated hernia complications 6
- Elevated D-dimer levels correlate strongly with intestinal ischemia 6
- Elevated creatine phosphokinase (CPK) is associated with complicated hernias 1
Clinical Pitfalls to Avoid
- Do not dismiss mild or intermittent symptoms - small ventral hernias can still incarcerate and strangulate 1
- Educate all patients with uncomplicated hernias about red flag symptoms (increasing pain, irreducibility, vomiting) that require immediate return for evaluation 1
- Never delay surgical intervention when strangulation is suspected, as elapsed time from symptom onset to surgery is the most important prognostic factor for mortality 1
- Delayed treatment beyond 24 hours in strangulated hernias significantly increases mortality 1